Peer Review Key Worker Policy: NICaN Guidelines

  1. Background

At the July 7th, 2008 meeting of the Peer Review Reference Group, concerns were raised about several issues related to developing and implementing a Key Worker Policy. Specificconcerns included the definition of “key worker”, as well as the difficulties inherent in maintaining a continuous key worker as the patient moves along the pathway.

The following guidelines, gleaned from reviewing several existing policies, may assist your MDT’s in developing a Key Worker Policy.

B. Peer Review Measure

“There should be an operational policy whereby a single named key worker for the patients’ care at a given time is identified by the MDT for each individual patient and the name and contact number of the current key worker is recorded in the patients’ case notes. The responsibility for ensuring that the key worker is identified should be that of the nurse MDT member(s). “

C. Suggested Points for Inclusion in a Key Worker Policy

  1. Definition:

The Key Worker is a “person who, with patient’s consent and agreement, takes a key role in co-ordinating the patient’s care and promoting continuity, ensuring the patient knows who to access for information and advice.” (NICE, 2004).

  1. Who Should the Key Worker Be?

The Key Worker must be a core member of the MDT team. In most instances the Key Worker shall be a CNS, but as appropriate, the Key Worker may be an Allied Health Professional, the Community Specialist Palliative Care Team, or the Medical Consultant.

  1. Role of the Key Worker:
  • Contribute to the MDT discussion and decision about the patient’s care plan .
  • Act as key point of contact for patients and their carers.
  • Be present when the cancer diagnosis is discussed and at any other key points in the patient’s journey.
  • Provide verbal and written information with regard to diagnosis, investigations, treatment options and support groups.
  • Lead in patient communication issues and co-ordination of the patient pathway.
  • Lead in the co-ordination of the assessment of patient’s needs.
  1. Process for Identifying Key Worker:

The Peer Review Measure states that the responsibility for ensuring that the Key Worker is identified should be that of the nurse MDT member(s).

The Key Worker’s name should be recorded in all relevant patient records and relevant health professionals informed of the name (e.g., letters to GP). The recording of the Key Worker information could easily be accomplished by using a patient checklist in the notes addressing the following:

a) patient has been offered a key worker

b) information offered about the MDT

c) the opportunity of a permanent record or summary of a consultation at which patient’s treatment options were discussed

d) patient offered range of information related to diagnosis, treatment, support groups, financial support, etc.

With the patient’s agreement, the patient should be informed of the name of their Key Worker verbally and be provided with a written version of their name and contact number, including what arrangements have been made for cover, after-hours, etc.

  1. Changes to the Key Worker:

It is quite likely that over the course of the patient’s care pathway, for various reasons, the Key Worker will change. Your policy should address this by stating how the patient, their carers, and other relevant health professionals will be informed of any change. Additionally, such changes should be documented in the patient notes. Ideally, such changes would be kept to a minimum.

  1. Competencies for Key Worker Role:

Some MDT Key Worker policies include a list of competencies for this role as an appendix to the policy. Attached is a sample should you wish to include this.

  1. Evidence Required to Meet this Measure:

Two pieces of evidence are required to show full compliance with this measure:

  • Operational Policy: written Key Worker policy contained in MDT Operational Policy;
  • Case note review undertaken by reviewers on the day of the visit: reviewers will expect to see a record of the patient’s key worker in their notes.

Key Worker Competencies

  • Work as an integral member of the MDT to ensure continuity of patient care.
  • Initiate and participate in MDT discussion and case conferences with all professionals involved in the delivery of patient care.
  • Communicate and co-ordinate information to patients and carers, evaluating their levels of understanding and utilising a range of skills/techniques to overcome any communication difficulties.
  • Demonstrate ability to verbally summarize patient information to facilitate understanding.
  • Act as an advocate for the patient who has or may have cancer.
  • Act as a communication resource and co-ordinator for other members of the multi-professional team in the care of the key worker’s patient caseload.
  • In conjunction with the MDT, provide patients with comprehensive information on the options available to them for treatment and care.
  • Be aware of any relevant clinical trials within the speciality.
  • Utilize specialist knowledge and skills regarding disclosure of information.
  • Co-ordinate the onward referral of patient and/or family members to appropriate clinical or support services.
  • Ensure accurate follow-up documentation is maintained including any changes in the named key worker.
  • Utilize support strategies and interventions available to care for patients with complex needs.
  • Demonstrate knowledge of holistic cancer care relating to areas such as screening, curative and palliative treatment, spiritual care, aspects of nutrition and pharmacology, rehabilitation, discharge and collaborative working.
  • Utilize all forms of patient information to enable the patient to have a better understanding of their diagnosis and treatment plan. This will include the use of specific resources for patients/carers from minority groups.
  • Facilitate the development of teaching and learning skills used to educate patients and other personnel.

Version 1, August 2009